Dr. Roach: Reflux surgery does have side effects

Dear Dr. Roach: I am so tired of gastric juices coming up and spraying my mouth. I am currently on a “last resort” medicine. My doctor wants to try it for three weeks. If it doesn’t work, he’s going to perform a Nissen fundoplication. From what I’ve read, there would be nothing more coming up. Could you explain this procedure? What will happen with swallowed air, and what will happen if I get sick to my stomach and (shudder) need to vomit? — S.S.

Answer: Large volumes of stomach acid coming into the mouth is an accepted indication for surgical treatment of reflux disease. Sometimes, the acid is associated with excess saliva and is called “water brash.”

Prior to considering surgery, it is worthwhile to make sure the medication treatment is as good as it can be. Proton pump inhibitors such as omeprazole should be taken 30 minutes before eating. Weight loss is helpful if overweight. Raising the head of the bed 6 to 8 inches (by inserting blocks under the legs of the head of the bed or using a plastic wedge under the mattress) and avoiding dietary triggers (coffee, chocolate, carbonated drinks, high-fat foods) should be tried. Baclofen, a powerful muscle relaxant with many possible side effects, may be the “last resort” medicine you are taking.

When all else fails, surgery may relieve symptoms. A Nissen fundoplication is when the upper part of the stomach, the fundus, is plicated (wrapped) around the esophagus and stitched in place. This can be done via endoscopy or as an open procedure. It is effective at reducing symptoms in 85 percent to 90 percent of patients.

Most people are unable to vomit and have less or no ability to belch, leading to bloating, increased intestinal gas and flatulence. Discomfort during eating is common. There are modifications of the surgical procedure designed to reduce side effects and complications while maintaining effectiveness, but a description of what these all are technically is in your surgeon’s domain.

Dear Dr. Roach: I have been taking Lipitor for high cholesterol. Lately, my pharmacist said that all statins can cause memory loss. I hesitate to stop taking Lipitor, but I don’t want this side effect. Please advise. — P.C.

Answer: Your pharmacist is quite right that some users of statins can have the unwanted side effect of memory loss. This is quite variable: Some people never get this effect, and it can be quite severe in a few. It appears to be reversible in the majority of people who get it. I wouldn’t recommend stopping unless you are having the side effect.

Dear Dr. Roach: I read in a medical advice column that tea tree oil can help cure nail fungus on my big toe, which I have had for more than 10 years. It did dramatically reduce the inflammation around the nail, but the nail is unchanged, and the inflammation subsequently returns. Recently, though, I have seen or heard of several nail fungus treatments that do not present a danger of liver damage. Are there any new treatments for the nail fungus that actually are effective? — J.S.

Answer: According to the Natural Medicines Comprehensive Database, 100 percent tea tree oil cream, applied twice daily for six months, is effective at curing infection in only 18 percent of people who try it. Most people have some benefit that isn’t permanent, as you did.

The only highly effective medicines I can find good evidence about, with cure rates of 50 percent to 75 percent, all have the possibility, albeit small, of liver damage.